Compliance • Audits/Analysis • Reimbursement/Regulatory/Rehab • Education/Efficiency • Survey
Mom was Right - the Answer is in Your Hands
Septicemia and urinary tract infections are identified as the primary reasons for patients to require care in a skilled nursing facility after a hospitalization. In the report, Adverse Events in Skilled Nursing Facilities (Levinson, D, & General, I, 2014), 26% of the adverse events identified for individuals entering nursing facilities were infection related. These two factors are key reasons why the changes to the Requirements of Participation focused on prevention and addressing infection control. Key changes included the Phase 2 requirement for implementation of antibiotic stewardship. Phase 3, due November 28, 2019, involves the requirement for a qualified infection preventionist who is a member and participant in the Quality Assurance and Assessment committee. This is a key strategy of the Centers for Medicare and Medicaid, aimed at improving care in nursing facilities through reducing risks of infection and decreasing unnecessary use of antibiotics.
Infections are costly events in nursing facilities, with between $38 and 137 million spent annually on antimicrobial therapy with another $673 million to $2 billion in infection related hospitalizations. Since the most common concern is that of urinary tract infections, many of the initial efforts have revolved around changing the commonly held misperceptions about urinary tract infections and older adults. Progress is occurring, as demonstrated in the Quality Measures below.
There are several programs that can be helpful as nursing facilities prepare for the new infection prevention regulations.
Following are four key actions that should be considered:
- Education for the infection preventionist: There are several course options, with some available for a very low of no expense. The requirement is that the infection preventionist receive specialized training in infection prevention. The course developed by CMS and CDC is expected to be available this spring and will be an online option available at no cost.
- Leadership evaluation of the effectiveness of the antibiotic stewardship program: The most effective antibiotic stewardship programs start with leadership commitment. Culture is difficult to change. Between well-intentioned families demanding antibiotics because, “every time grandma gets confused like this it is a urinary tract infection;” hospital emergency departments over-testing elderly patients for urinary tract infections, and physicians providing call coverage of nursing facilities ready to supply the order for an antibiotic, the hurdles to antibiotic stewardship seem insurmountable. Strong leadership support of the antibiotic stewardship program can make the difference in reducing antibiotic overuse.
- A spot at the QAPI table for the infection preventionist: Antibiotic stewardship, review of any infection prevention concerns including hand hygiene and addressing any of the key infection prevention concerns should be an ongoing agenda item in the QAA committee meeting.
- Education for the staff: As of November 28, 2019, training in infection prevention is a required annual educational program. While most organizations implemented this requirement long ago, it is important to be aware that the training requirement now extends to all staff, contractors and volunteers.
While each of the above strategies is important, clearly the most essential ingredient in a successful infection prevention program is the one we all learned as kids. Remember to wash your hands!
Harmony Healthcare International (HHI) is available to provide assistance. You can contact us by clicking here. Looking to train your staff? Join us in person at one of our upcoming Competency/Certification Courses. Click here to see the dates and locations.
 Levinson, D. R., & General, I. (2014). Adverse events in skilled nursing facilities: National incidence among Medicare beneficiaries. Washington DC: Department of Health and Human Services.
 Richards CL. Infections in residents of long-term care facilities: an agenda for research. Report of an expert panel. J Am Geriatr Soc. 2002;50:570-6. PMID: 11943058.